Clinical, imaging, arthroscopic, and histologic features of bilateral anteromedial meniscofemoral ligament: A case report.

BACKGROUND: The anteromedial meniscofemoral ligament (AMMFL) is a very rare entity, commonly unrecognized and underreported. Although it was not proved to be a cause of anterior knee pain, concerns have been raised on the relationship between the presence of this structure and medial meniscus injury secondary to its abnormal motion. Regarding histologic examination, some studies have shown meniscus-like fibrocartilage, while others have identified it as ligament-like collagenous fibrous connective tissue. CASE SUMMARY: We report the case of a 34-year-old ballerina with an AMMFL associated with a torn medial meniscus of both knees. Surgery was performed to treat the meniscal injury and two biopsies of each AMMFL were taken in different locations to define the histopathological composition. Histologic examination revealed fibrocartilaginous tissue compatible with meniscus. Follow-up evaluation one year after surgery evidenced full remission of symptoms and the patient had resumed her athletic activities. CONCLUSION: Clinical, magnetic resonance imaging, arthroscopic, and histological features have been carefully described to better characterize the AMMFL.

Glenoid index: a new risk factor for recurrence of glenohumeral instability after arthroscopic Bankart repair.

Background: The glenoid index (GI) (glenoid height to width ratio) has been shown to be a risk factor for instability in young healthy athletes. Nevertheless, whether the altered GI is a risk factor for recurrence after a Bankart repair remains unknown. Methods: Between 2014 and 2018, 148 patients ≥ 18 years old with anterior glenohumeral instability underwent a primary arthroscopic Bankart repair in our institution. We assessed return to sports, functional outcomes, and complications. We evaluate the association between the altered GI and the probabilities of recurrence in the postoperative period. Intraclass correlation coefficient was used to determine interobserver reliability. Results: The mean age at the time of surgery was 25.6 years old (19 to 29), and the mean follow-up was 53.3 months (29 to 89). The 95 shoulders who met the inclusion criteria were divided into 2 cohorts, 47 shoulders had a GI ≤ 1.58 (group A) and 48 had a GI > 1.58 (group B). At the final follow-up, 5 shoulders in group A (10.6%) and 17 shoulders in group B (35.4%) suffered a recurrence of instability. Those patients with a GI > 1.58 had a hazard ratio of 3.86 (95% confidence interval: 1.42-10.48) (P = .004) compared with those with a GI ≤ 1.58 of suffering a recurrence. When correlating GI measurements between raters, we observed an intraclass correlation coefficient of 0.76 (95% confidence interval: 0.63-0.84), these results fall under the qualitative definition of good interobserver agreement. Conclusion: In young active patients with an arthroscopic Bankart repair, an increased GI was associated with a significantly higher rate of postoperative recurrences. Specifically, those subjects with a GI > 1.58 had 3.86 times the risk of recurrence than those subjects with a GI ≤ 1.58.

Displasia fibrosa de columna lumbar en una mujer de mediana edad: Presentación de un caso / Fibrous dysplasia of the lumbar spine in a middle-aged woman. Case presentation

La displasia fibrosa es una lesión ósea benigna caracterizada por el desarrollo anormal del tejido fibroso de disposición arremolinada, con trabéculas de hueso inmaduro no laminar. Se distinguen dos formas: monostótica y poliostótica. El compromiso de columna vertebral se asocia, con más frecuencia, a la variedad poliostótica; la forma monostótica es infrecuente. Presentamos a una mujer de 46 años que consultó por lumbocruralgia derecha de dos meses de evolución, con diagnóstico definitivo de displasia fibrosa de columna lumbar. Los estudios por imágenes mostraron una lesión monostótica lítico-quística con tabiques internos localizada en el arco posterior de la quinta vértebra lumbar. Sus características en los estudios por imágenes sugirieron un quiste óseo aneurismático, mientras que la anatomía patológica fue reveladora frente al diagnóstico final de displasia fibrosa. Los síntomas menores y la ausencia de complicaciones llevaron a indicar un tratamiento conservador. Si bien el compromiso de columna lumbar por displasia fibrosa monostótica es infrecuente, debería considerarse entre los diagnósticos diferenciales de una lesión lítica solitaria en dicha localización. No obstante, no se descarta mediante histopatología que pueda tratarse de un caso de coexistencia de displasia fibrosa y quiste óseo aneurismático o que la displasia fibrosa se haya desarrollado sobre un quiste óseo aneurismático. Nivel de Evidencia: IV

Fibrous dysplasia (FD) is a benign skeletal disorder characterized by abnormal development of fibrous tissue in a whorled pattern and containing trabeculae of immature non-lamellar bone. FD has two forms of clinical presentations: monostotic and polyostotic. Spinal involvement is seen mostly in the polyostotic form and is very unusual in the monostotic form. We present a 46-year-old woman that complained of right low back pain with a 2-month evolution. The definitive diagnosis was FD of the lumbar spine. Imaging testing revealed a lytic-cystic monostotic lesion with internal septa located in the posterior arch of the fifth lumbar vertebra, suggestive of Aneurysmal Bone Cyst (ABC). However, the anatomical pathology revealed FD as the final diagnosis. Conservative treatment was undertaken due to minimal symptoms and the absence of complications. Although monostotic FD of lumbar spine is rare, it should be taken into account among the differential diagnoses of a single osteolytic lesion. However, histopathology testing cannot rule out the coexistence of FB and ABC or a setting of FB secondary to an ABC. Level of Evidence: IV

Variantes anatómicas del tendón de la porción larga del biceps en su segmento intra-articular. Presentación de 2 casos y revisión bibliográfica / Developmental anormalities of the tendon of the long head of the biceps

Las anomalías del desarrollo del tendón de la porción larga del bíceps son poco frecuentes. La detención de la migración evolutiva del tendón hacia intra-articular durante las primeras semanas de la vida embrionaria y fetal darán lugar a las múltiples variantes anatómicas del segmento intra-articular del tendón. Presentamos 2 casos de variantes anatómicas del tendón de la porción larga del bíceps en su segmento intra-articular diagnosticadas sólo luego de la exploración artroscópica gleno-humeral. El tratamiento de estas anomalías congénitas depende en gran media del examen físico preoperatorio y del grado de movilidad que presente el tendón durante la exploración artroscópica.

Developmental anomalies of the tendon of the long head of the biceps are rare. The arrest of evolutionary migration of the tendon towards intra-articular during the first weeks of embryonic and fetal life will result in multiple anatomic variants of the intra-articular tendon segment. We report 2 cases of anatomical variants of the tendon of the long head of the biceps in its intra-articular segment diagnosed only after gleno-humeral arthroscopic examination. Treatment of these congenital anomalies depend to a large extent on preoperative physical examination as well as on mobility achieved by the tendon during arthroscopic examination.